ESA Safety Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Required PPE

• Respirators Required<br>

  Yes

  No

  N/A

• In Use

  Yes

  No

  N/A

• Hardhats Needed

  Yes

  No

  N/A

• In Use

  Yes

  No

  N/A

• Safety Glasses Needed

  Yes

  No

  N/A

• In Use

  Yes

  No

  N/A

• Gloves Needed

  Yes

  No

  N/A

• In Use

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

Fall Protection

• Work over 6ft.

  Yes

  No

  N/A

• Harness/Lanyard

  Yes

  No

  N/A

• Type of tieoff

• Gaurdrails

  Yes

  No

  N/A

Ladders

• Stepladders

  Yes

  No

  N/A

• Properly Used

  Yes

  No

  N/A

• If No who

• Extention Ladders

  Yes

  No

  N/A

• Properly Used

  Yes

  No

  N/A

• If No Who?

Electrical

• Extension Cords

  Yes

  No

  N/A

• Good Condition

  Yes

  No

  N/A

• Elevated/Protected

  Yes

  No

  N/A

• GFCI

  Yes

  No

  N/A

• Lockout Needed

  Yes

  No

  N/A

• Portable Lights

  Yes

  No

  N/A

• Gaurds On Lights

  Yes

  No

  N/A

Scaffold

• Over 10ft High

  Yes

  No

  N/A

• Gaurdrails

  Yes

  No

  N/A

• Toe Boards

  Yes

  No

  N/A

• Base Plates/Casters

  Yes

  No

  N/A

• Casters Locked

  Yes

  No

  N/A

• Solid Surface

  Yes

  No

  N/A

• Mud Sills

  Yes

  No

  N/A

• Access to Scaffold

Confined Space

• Confined Space

  Yes

  No

  N/A

• Space Tested

  Yes

  No

  N/A

• Permit Required

  Yes

  No

  N/A

Trenches

• Trenches

  Yes

  No

  N/A

• Approx Depth

• Access Required

  Yes

  No

  N/A

• Protection Required

  Yes

  No

  N/A

• If under 5ft is required protection due to employee function

  Yes

  No

  N/A

• Is excavation equipment on site and operating

  Yes

  No

  N/A

• Employees clear of equipment in operation

  Yes

  No

  N/A

Welding/Cutting

• Welding/Cutting

  Yes

  No

  N/A

• Welding/Cutting PPE

  Yes

  No

  N/A

• If No Who

• Acetylene and Oxygen stored 20ft apart

  Yes

  No

  N/A

• Tanks Secure

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

Housekeeping

• Isles Clear

  Yes

  No

  N/A

• Debris Clear

  Yes

  No

  N/A

OTHER

• Other Safety Issues

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